- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.68 / $1,821.00 / $9,477.00
| Facility | | $168.68 | $1,821.00 | $9,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.41 / $171.35 / $309.98
| Professional | | $134.41 | $171.35 | $309.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.07 / $3,206.07 / $3,206.07
| Facility | | $3,206.07 | $3,206.07 | $3,206.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,240.00 / $2,268.00 / $5,626.00
| Facility | | $1,240.00 | $2,268.00 | $5,626.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.84 / $316.49 / $498.82
| Professional | | $238.84 | $316.49 | $498.82 |